The Current Role of Arthroscopy in Traumatic Wrist Injuries: An Expert Survey

Abstract

Background Wrist arthroscopy has become increasingly popular for diagnosing and treating traumatic wrist injuries. How wrist arthroscopy has influenced the daily practice of wrist surgeons remains unclear. The objective of this study was to evaluate the role of wrist arthroscopy for the diagnosis and treatment of traumatic wrist injuries among members of the International Wrist Arthroscopy Society (IWAS).

Methods An online survey was conducted among IWAS members between August and November 2021 with questions regarding the diagnostic and therapeutic importance of wrist arthroscopy. Questions focused on traumatic injuries of the triangular fibrocartilage complex (TFCC) and scapholunate ligament (SLL). Multiple-choice questions were presented in the form of a Likert scale. The primary outcome was respondent agreement, defined as 80% answering similarly.

Results The survey was completed by 211 respondents (39% response rate). The majority (81%) were certified or fellowship-trained wrist surgeons. Most respondents (74%) had performed over 100 wrist arthroscopies. Agreement was reached on 4 of the 22 questions. It was agreed that the outcomes of wrist arthroscopy strongly depend on surgeons' experience, that there is sufficient evidence for the diagnostic purposes of wrist arthroscopy, and that wrist arthroscopy is better than magnetic resonance imaging (MRI) for diagnosing TFCC and SLL injuries. No agreement was reached on the preferred treatment of any type of TFCC or SLL injury.

Conclusion There is agreement that wrist arthroscopy is superior to MRI for diagnosing traumatic TFCC and SLL injuries, yet experts remain divided on the optimal management. Guidelines need to be developed for the standardization of indications and procedures.

Level of Evidence This is a Level III study.

Keywords

wrist arthroscopy - survey - IWAS - ligaments - traumatic wrist injuries - TFCC - scapholunate

Note

The study was designed and conducted from the Maasstad Hospital in Rotterdam.

Ethical Review Approval

Since this study did not involve patients, no approval was necessary from the ethics review board.

^* For Members of IWAS, please refer [Supplementary Appendix A].

Publikationsverlauf

Eingereicht: 12. Mai 2022

Angenommen: 12. Mai 2022

Artikel online veröffentlicht:
01. August 2022

• References

• 1 Viswanath A, Talwalkar S. Recent advances and future trends in wrist arthroscopy. J Arthrosc Surg Sport Med 2020; 1 (01) 65-72
• 2 Magee T. Comparison of 3-T MRI and arthroscopy of intrinsic wrist ligament and TFCC tears. AJR Am J Roentgenol 2009; 192 (01) 80-85
• 3 Mahmood A, Fountain J, Vasireddy N, Waseem M. Wrist MRI arthrogram v wrist arthroscopy: what are we finding?. Open Orthop J 2012; 6: 194-198
• 4 Atzei A. New trends in arthroscopic management of type 1-B TFCC injuries with DRUJ instability. J Hand Surg Eur Vol 2009; 34 (05) 582-591
• 5 Geissler WB, Freeland AE, Savoie FH, McIntyre LW, Whipple TL. Intracarpal soft-tissue lesions associated with an intra-articular fracture of the distal end of the radius. J Bone Joint Surg Am 1996; 78 (03) 357-365
• 6 Mathoulin C, Gras M. Role of wrist arthroscopy in scapholunate dissociation. Orthop Traumatol Surg Res 2020; 106 (1S): S89-S99
• 7 Yan B, Xu Z, Chen Y, Yin W. Prevalence of triangular fibrocartilage complex injuries in patients with distal radius fractures: a 3.0T magnetic resonance imaging study. J Int Med Res 2019; 47 (08) 3648-3655
• 8 Lans J, Lasa A, Chen NC, Jupiter JB. Incidence and functional outcomes of scapholunate diastases associated distal radius fractures: a 2-year follow-up scapholunate dissociation. Open Orthop J 2018; 12: 33-40
• 9 Liu EH, Suen K, Tham SK, Ek ET. Surgical repair of triangular fibrocartilage complex tears: a systematic review. J Wrist Surg 2021; 10 (01) 70-83
• 10 Selles CA, d'Ailly PN, Schep NWL. Patient-reported outcomes following arthroscopic triangular fibrocartilage complex repair. J Wrist Surg 2020; 9 (01) 58-62
• 11 Wahegaonkar AL, Mathoulin CL. Arthroscopic dorsal capsulo-ligamentous repair in the treatment of chronic scapho-lunate ligament tears. J Wrist Surg 2013; 2 (02) 141-148
• 12 Del Piñal F. Arthroscopic volar capsuloligamentous repair. J Wrist Surg 2013; 2 (02) 126-128
• 13 Carratalá V, Lucas FJ, Miranda I, Sánchez Alepuz E, González Jofré C. Arthroscopic scapholunate capsuloligamentous repair: suture with dorsal capsular reinforcement for scapholunate ligament lesion. Arthrosc Tech 2017; 6 (01) e113-e120
• 14 Obdeijn MC, Tuijthof GJ, van der Horst CM, Mathoulin C, Liverneaux P. Trends in wrist arthroscopy. J Wrist Surg 2013; 2 (03) 239-246
• 15 Palmer AK. Triangular fibrocartilage complex lesions: a classification. J Hand Surg Am 1989; 14 (04) 594-606
• 16 Leclercq C, Mathoulin C. Members of EWAS. Complications of wrist arthroscopy: a multicenter study based on 10,107 arthroscopies. J Wrist Surg 2016; 5 (04) 320-326
• 17 Boer BC, Vestering M, van Raak SM, van Kooten EO, Huis In 't Veld R, Vochteloo AJH. MR arthrography is slightly more accurate than conventional MRI in detecting TFCC lesions of the wrist. Eur J Orthop Surg Traumatol 2018; 28 (08) 1549-1553
• 18 Adams BD, Berger RA. An anatomic reconstruction of the distal radioulnar ligaments for posttraumatic distal radioulnar joint instability. J Hand Surg Am 2002; 27 (02) 243-251
• 19 Garcia-Elias M, Smith DE, Llusá M. Surgical approach to the triangular fibrocartilage complex. Tech Hand Up Extrem Surg 2003; 7 (04) 134-140
• 20 Kleinman WB. Stability of the distal radioulna joint: biomechanics, pathophysiology, physical diagnosis, and restoration of function what we have learned in 25 years. J Hand Surg Am 2007; 32 (07) 1086-1106
• 21 Murray D, Javed S, Hayton M. Mini dorsal incision to the triangular fibrocartilage complex: a new surgical approach. Hand (N Y) 2015; 10 (04) 717-720
• 22 Geissler WB. Arthroscopic management of scapholunate instability. J Wrist Surg 2013; 2 (02) 129-135
• 23 Mathoulin CL. Indications, techniques, and outcomes of arthroscopic repair of scapholunate ligament and triangular fibrocartilage complex. J Hand Surg Eur Vol 2017; 42 (06) 551-566
• 24 Garcia-Elias M, Lluch AL, Stanley JK. Three-ligament tenodesis for the treatment of scapholunate dissociation: indications and surgical technique. J Hand Surg Am 2006; 31 (01) 125-134
• 25 Ho PC, Wong CW, Tse WL. Arthroscopic-assisted combined dorsal and volar scapholunate ligament reconstruction with tendon graft for chronic SL instability. J Wrist Surg 2015; 4 (04) 252-263
• 26 Brunelli GA, Brunelli GR. [A new surgical technique for carpal instability with scapho-lunar dislocation. (Eleven cases)]. Ann Chir Main Memb Super 1995; 14 (4-5): 207-213
• 27 Dreant N, Dautel G. [Development of a arthroscopic severity score for scapholunate instability]. Chir Main 2003; 22 (02) 90-94
• 28 Messina JC, Van Overstraeten L, Luchetti R, Fairplay T, Mathoulin CL. The EWAS classification of scapholunate tears: an anatomical arthroscopic study. J Wrist Surg 2013; 2 (02) 105-109
• 29 Saito T, Sterbenz JM, Chung KC. Chronologic and geographic trends of triangular fibrocartilage complex repair. Hand Clin 2017; 33 (04) 593-605